fluids and shock

Question 1

edema

Answer 1

excess interstitial fluid (localized or systemic)

Question 2

transudates

Answer 2

salt water, little too protein content

results from: starling forces, lymphatic failure, heart failure, cirrhosis, renal failure, salt-indulgence

Question 3

starling forces

Answer 3

things that contribute to fluid exchange in capillary wall

Question 4

hydrostatic pressure

Answer 4

what causes fluids to move out of vessels (higher in capillaries than in tissue)

Question 5

oncotic pressure

Answer 5

pressure induced by plasma proteins, stays the same, forces water into capillaries

Question 6

starling forces inbalance

Answer 6

higher hydrostatic pressure or lower oncotic pressure causes too much for lymphatics to pick up

Question 7

net filtration pressure

Answer 7

hydrostatic pressure - oncotic pressure (higher at arteriole end than venue end because HP changes)

Question 8

transudative edema

Answer 8

excess total body water, salt/fluid overloading, excess aldosterone (tumors, hepatic failure), kidney failure, systemic veins (all)-R heart failure, pulmonary veins-L heart failure, leg veins, prolonged standing (pregnancy valve failure), portal vein-cirrhosis (drops oncotic pressure because plasma proteins not being made as much due to cirrhosis), cerebral capillaries (brain trauma), systemic capillaries, lymphatic obstruction, cancer, radiation

Question 9

exudates

Answer 9

protein rich salt water; results from overly leaky capillaries
inflammation, sepsis, burns, abnormal capillaries in tumors

Question 10

hemorrhage

Answer 10

loss of whole blood from blood vessels (external, in tissues, or third spaces)
causes: trauma, diseases of vessels, diseases around vessels, lack of clotting factors, lack of platelets

Question 11

class I hemorrhage

Answer 11

up to 750 mL; minimal to no clinical signs

Question 12

class II hemorrhage

Answer 12

750ml-1500ml; tachycardia, tachypenia, anxiety

Question 13

class III hemorrhage

Answer 13

1500-2000ml; Tachycardia, tachypnea, hypotension, altered mental status – may lead to irreversible shock

Question 14

class IV hemorrhage

Answer 14

2000mL; Tachycardia, hypotension, cold, clammy, severely altered mental status – may lead to irreversible shock

Question 15

shock

Answer 15

widespread hypo perfusion of body tissues; leads to organ malfunction/failure; BP may be maintained; lactic acidosis; release of inflammatory mediators

Question 16

hypovolemic shock

Answer 16

decrease in blood volume; hemorrhage, vomiting, diarrhea, burns, third-space losses

Question 17

cariogenic shock-pump failure

Answer 17

massive heart attack, rupture of ventricle or valve, some rhythm disturbances

Question 18

disruptive shock

Answer 18

warm shock, profound vasodilation, lack of venous return

sepsis, anaphylaxis, high spinal cord injury, profound anesthesia, vasovagal (pain, emotion), nerve war gases

Question 19

obstructive shock

Answer 19

external compression of heart or its outflow; tension pneumothorax, large pericardial effusion, massive pulmonary embolism

Question 20

compensated stage

Answer 20

blood shunted from kidneys, salivary glands, gut, skin; maintains perfusion to heart and brain;drymouth and skin, few urine, BP maintained

Question 21

progressive shock

Answer 21

sympathetic compensatory mechanisms fail, BP and cardiac output drop, lung and kidney damage occurs, survival unlikely

Question 22

levophed

Answer 22

Norepinephrine, will fix BP but cause more problems

Question 23

goal of shock treatment

Answer 23

restore perfusion, not simply raise BP, control bleeding, fluids!, address underlying cause